Global health has become expert at establishing what a war does to a population and has built almost nothing that would stop the next one. A new Comment in The Lancet Global Health co-authored by Dr Adam Coutts, a Centre for Business Research Research Associate at Cambridge Judge Business School, argues that this is not a gap in the evidence – but is rather a gap in willingness held in place by how institutions are funded, mandated and rewarded.
We have been monitoring misery for too long. Monitoring is not the same as ending it.
The authors contend in the Comment, entitled Beyond monitoring misery during conflict: the political economy of global health reform, that the sector is paid to monitor and paid for very little else. The institutions, including UN agencies, donor governments and the university-based commissions that advise them, run sophisticated machinery for mortality estimation, attacks-on-healthcare reporting and needs assessment. The machinery for accountability barely exists. Power, financing and governance stay where the incentives leave them, which is untouched.
Adam Coutts said: “We have been monitoring misery for too long. Monitoring is not the same as ending it.”
Reforms in health institutions stalled by funding incentives
One everyday observation carries most of the case. Ask anyone in the sector privately whether health in conflict is political and the answer comes back without hesitation. That answer rarely reaches the published output. The analysis exists, but it stops at the door of the institution that would have to act on it.
The argument is equally direct about recent flagship reform reviews, which diagnose the problem accurately and then dissolve it. They conclude that reform commitments stalled because donor incentives and institutional mandates were never confronted, and then address their recommendations to those same actors, holding those same incentives, and expect different behaviour. A recommendation that does not change what an institution is rewarded for is not a reform. It is a record of having noticed.
Humanitarian neutrality is not the same as technical neutrality that reflects politics
Central to the argument is a distinction between 2 things the field treats as one. Humanitarian neutrality, the operational duty to assist all civilians regardless of affiliation, is a precondition for protected access and is defended without qualification. Technical neutrality is the bracketing of political accountability in the name of impartiality by researchers, evaluators and agencies that are not themselves delivering care. It borrows the moral standing of the first while carrying none of its risk, and in practice it protects budgets, mandates and access while leaving intact the conditions that generate the casualties being counted.
Fifteen years of field research across Syria, Lebanon, Gaza and Jordan sit behind the argument. What follows from it is a political economy approach that treats political decisions, donor incentives and governance structures as determinants of health outcomes in conflict rather than as background conditions.
From redefining the health mission to embedding new practices
The Comment proposes 6 concrete shifts, each specifying who must act:
- redefining the mission: from parallel delivery to state capacity
- accountability infrastructure: independent evaluation with teeth
- economic enforcement of IHL: making military suppliers bear cost
- regional health intelligence: distributed, not centralised
- data harmonisation and procurement transparency
- bridging the knowing-doing gap: embedded practice for global health researchers
Health institutions have the analysis to stop harm, but not the will
Dr Vlad Chaddad, one of the authors, said: “We keep asking the same actors, holding the same incentives, to behave differently because another report recommends it. That is not a reform strategy. Fund an evaluation body that no government can defund and that publishes without clearance, and you have changed the incentive rather than the recommendation.”
We need interventions that work and are fit for local economic, social and political contexts not ones transplanted en masse from the EU and US.
Adam Coutts adds: “We need interventions that work and are fit for local economic, social and political contexts not ones transplanted en masse from the EU and US.”
Simon Deakin, CBR Director, adds: “It is vital that lessons are learned from the research carried out in Cambridge and elsewhere on the relationship between conflict and health. This is an issue which affects us all.”
The authors are not arguing that global health lacks the analysis. They are arguing that it has the analysis and files it. The question they leave open is what the field would look like if the rigour it applies to counting the harm were applied to naming who causes it and who pays for it to continue.
Related content
Coutts, A.P., Orcutt, M., Sullivan, R., Ekzayez, A. and Chaddad, V. (2026) “Beyond monitoring misery during conflict: the political economy of global health reform.” The Lancet Global Health: 104038 (DOI: 10.1016/j.langlo.2026.104038)
Facts Only
* Dr Adam Coutts is a Research Associate at the Cambridge Judge Business School Centre for Business Research.
* Dr Vlad Chaddad is a co-author of a Comment in The Lancet Global Health.
* The publication is titled "Beyond monitoring misery during conflict: the political economy of global health reform."
* The research is based on fifteen years of field research in Syria, Lebanon, Gaza, and Jordan.
* The authors propose six shifts: redefining missions toward state capacity, creating independent evaluation infrastructure, economic enforcement of International Humanitarian Law (IHL) via military suppliers, distributed regional health intelligence, data harmonisation/procurement transparency, and embedding researchers in practice.
* Entities identified as part of the current global health machinery include UN agencies, donor governments, and university-based commissions.
* The Lancet Global Health published this content under DOI 10.1016/j.langlo.2026.104038.
* Simon Deakin is the Director of the Centre for Business Research.
Executive Summary
Global health institutions possess sophisticated capabilities for monitoring mortality and healthcare attacks in conflict zones but lack the mechanisms to stop the underlying causes of these crises. There is a systemic gap between the analysis of health outcomes in war and the willingness of funding bodies to act on that analysis. This failure is attributed to institutional mandates and donor incentives that reward the monitoring of misery rather than the implementation of structural reforms.
A critical tension exists between humanitarian neutrality—the duty to treat all civilians—and "technical neutrality," where researchers and agencies avoid political accountability to protect their budgets and access. To address this, proposed reforms suggest shifting from parallel service delivery to building state capacity and establishing an independent evaluation body that operates without government clearance. The goal is to move toward interventions tailored to local economic and political contexts rather than models transplanted from the US and EU.
Full Take
This scholarship applies a political economy lens to the humanitarian sector, treating donor incentives and governance structures as primary determinants of health, rather than mere background noise. The core contention is that the "knowing-doing gap" is not a failure of data, but a feature of the current funding architecture.
The methodology relies on fifteen years of qualitative field research across high-conflict zones. While the empirical grounding is strong, a peer reviewer would note the lack of a formal quantitative framework to measure "will" or "incentives." The claims are largely systemic and normative; they argue that the sector is structurally incentivized to maintain the status quo. The conclusions are proportionate to the findings, provided one accepts the premise that technical neutrality functions as a shield for political inaction.
This work challenges the traditional humanitarian paradigm by suggesting that "neutrality" can be weaponized to avoid accountability. If these findings hold, it implies that global health reform requires an external, "tooth-edged" evaluation body—effectively a move toward a supranational oversight mechanism that bypasses state sovereignty.
Bridge Questions:
1. How would a funding model designed for "ending misery" differ specifically in its KPIs from one designed for "monitoring misery"?
2. Can a truly independent evaluation body exist if it relies on the same global financial systems it seeks to critique?
Counterstrike Scan: An influence campaign would use this narrative to delegitimize international agencies (UN/WHO) to justify their defunding or replacement by private, non-neutral actors. The actual content does not match this; it advocates for structural reform and increased accountability within the mission of global health.